Brizy CT Funding Request – Charles City Elks Lodge #418

Application for Support

Each year the Charles City Elks Charitable Trust Board of Directors invests funds donated to the organization. Depending upon the success of these investments, the Board allocates a portion of these proceeds to be given to non-profit organizations in our community. If Charles City Elks members have an organization they feel might be worthy of investment from our Lodge, they should fill out the form below to submit your suggestion to the Board for possible funding.

PLEASE NOTE:

• NEW DEADLINES FOR THESE REQUESTS ARE SET EACH YEAR!

• DEPENDING UPON RETURN ON INVESTMENTS, THE BOARD MAY "SKIP" A YEAR OF FUNDING!

• APPLICATIONS FOR FUNDING WILL BE ACCEPTED FROM DECEMBER 1, 2023 - JANUARY 9, 2024.

Use this form to request funds for non-profit organizations. Applications for funds must be made by an active member of the Charles City Elks. THESE APPLICATIONS MUST BE SUBMITTED BEGINNING DECEMBER 1, 2023 AND BEFORE JANUARY 9, 2024 IN ORDER TO BE CONSIDERED FOR FUNDING!

Name

First

Last

Name of Elks member making request of funds for organization

Email of Elks member submitting this request*

Organization for which funds are being requested*

Contact Person

First

Last

Provide the name of a representative of the organization requesting financial assistance

Organization Mailing Address*

Provide a Street Address / PO Box for the organization requesting funds

City*

State*

Zip Code*

Phone Number of Contact Person

If available, please provide a phone number (including area code) of the Contact Person

Funds Requested*

Provide an estimate of the amount of funds being requested by this organization. WHOLE DOLLAR AMOUNTS ONLY - NO DECIMAL POINTS

How Will These Funds Be Used*

Provide pertinent information on how the requested funds would be used. Give as much information as is appropriate to help the Board of Directors in their decision.

Additional Information

Please provide any additional information that will help the Board of Directors in determining whether funds will be awarded, and if so, the dollar amount to be awarded.

Upload Supporting Information

Alternately, you may upload files that will give the Board additional information on the organization requesting funds, its purpose, history, or any other information that would be of assistance. Unfortunately we are unable to accept PDF files at this time.

Date

Time

This field should be left blank